Utilising positive behaviour support instead of seclusion timeouts in persons with autism

Abstract

Utilising Positive Behaviour Support instead of Seclusion Timeouts in Persons with Autism Normally, persons affected with autistic disorder are cared for in society, and only make contact with mental health facilities when they have a comorbid psychiatric disorder or when exhibiting some form of challenging behaviour which cannot be controlled in their home environment. In most mental health facilities around the world, the usual practice to manage these challenging behaviours is through the use of physical interventions such as seclusion or timeout. However, reduction of challenging behaviour by these means is only temporary and other interventions exist in the form of Positive Behaviour Supports PBS which may prove to be more effective. The objective of this study was to try and evaluate whether PBS was more effective than seclusion or timeout by conducting a broad search of the literature through the Bibliographic databases Academic Search Complete, Cinahl Plus Text, Psycholnfo and PubMed Central combinations of keywords or key-terms identified through the use of a PICO approach. The resultant papers were matched against stipulated inclusion and exclusion criteria and those which were relevant were further appraised using suitable critiquing tools. This left a final pool of 15 articles with which to evaluate the evidence and these consisted of: one non-randomized controlled trial, seven quantitative studies, and another seven single subject research design studies. The findings showed that the although it was common practice to seclude persons with autism to manage their challenging behaviours, there was little evidence to support this, and that the approach to utilizing PBS in mental health settings showed more promise. Nonetheless, in order for staff to have the skills and understanding to effectively manage the challenging behaviours, it was necessary to provide training and education. This also ensured that staff had more knowledge and confidence, and that a change in practice was maintained. As a result, this review makes several recommendations to address this.